By Nantaba Julianna

During this quarter, CEHURD has engaged with Health Unit Management Committees (HUMCs) in Kiboga and Kyankwanzi districts. This has been one as part of a three year participatory action research project titled “Health System Governance: Community Participation as a Key Strategy for Realizing the Right to Health.” This engagement entailed capacity building and community dialogues with members of HUMCs of Kikoolimbo Health Center in Kyankwanzi and Nyamiringa Health Center in Kiboga.

Although the project engaged various stake holders in the decentralized health system, there has been a specific focus on Health Unit Management Committees (HUMCs)  a structure establish by Ministry of Health to among others promote community participation the decentralized health system.

Community participation has been argued as one of the strategies that can be utilized in realizing the right to health given the role it can play in  promoting accountability of duty bearers to right’s holders and improving the effectiveness and sustainability of health interventions, programs and services in various ways. Community participation means that the community is no longer a passive recipient of health care, but an active participant in the creation of a health care system that serves their specific needs.

This action research has affirmed the role that HUMCs can play in facilitating health service accountability, since they are supposed to act as the interface between communities and points of care. It also revealed that challenges of these structures including; role confusion in what committee members’ duty and the lack of knowledge among community members on the role and existence of such structures.

Having identified these challenges, CEHURD team met with the members of these management committees, took them through a various process to enable them understand their roles and responsibilities during which they were empowered and organized a community dialogue with the communities which the health center serves. These community dialogues were utilized as an avenue for community members to understand the role of HUMCs and also air their challenges, improve on communication between service providers and patients and after work together on strategies to address the challenges.

This action research has reaffirmed that Civil Society can indeed play a role holding health services accountable and creating a sense of community ownership of health services (London, 2007). It has the potential to strengthen trust and good relationships between patients and health workers. It allows communities to participate in defining models of care and resource allocation in health and for communities to become involved in dealing with the social and economic determinants of health.

We acknowledge the role and contribution of Veronica Masanja (Nyamirina Health Facility in-charge) who took part in the re-search exchange visit during which best practices and models were shared, members of the two HUMCs who dedicated time to this process, District Health Officers of the two districts, our collaborating partners from the Learning Network for Health and Human Rights of the School of Public Health and Family Medicine at the University of Cape Town (UCT) and support from the International Development and Research Center(IDRC), Canada.

By Serunjogi Francis

Among the ways of eliminating health inequalities within communities is through carrying out advocacy to enable promotion of access to better health care services. Advocacy as put, the act of taking a position on an issue, and initiating actions in a deliberate attempt to influence policy choices may involve developing partnerships and creating structures geared towards promoting quality services delivery. On the other hand, community health advocacy involves taking action by the community itself with an aim of improving service delivery in health. This may involve creating programs, developing collaborations and partnerships and or, creating structures that can help to back up the process. Such structures can help to enhance community engagement ongoing projects and to increase community awareness of the issues being addressed.

In a bid to enhance community level advocacy, CEHURD with support AKIBA-UHAKI engaged community leaders and members in selecting a team of 15 Community advocates for health and human rights from three sub-counties in Buikwe district. The training was carried out with guidance from the protocol adapted from the Human rights and Gender mainstreaming for health professional manual which was developed and pretested  in collaboration with Ministry of Health and WHO in 2013.

Much as there are health structures at community level including the Health Unit Management Committees (HUMCs) and Village Health Teams (VHTs), Community advocates for health and human rights act as a monitoring tool and enhance accountability which is a key aspect of advocacy.

This community advocates were tasked to identifying and document health rights violations within their sub-counties; mobilize communities to seek for health services, operate as an Alternative Dispute Resolution (ADR) mechanism within their communities and to serve as a health services monitoring tool. Since CEHURD does advocacy at the national level, evidence gathered by these advocates is an added advantage to the ongoing processes.

The ever growing demand in health needs and the existence of inequities in resource allocation keeps calling for continuous energies in advocating for improved health care delivery right from the community levels. This therefore calls for persistence, dedication, and investment not only in energy but monies too if change is to be realized in the affirmative.  CEHURD therefore expects to further support these advocates in terms of monitoring their work and also continuously develop their capacity for better implementation.

By Rebecca Carr

This Summer I undertook an internship at the Centre for Health, Human Rights and Development, Uganda (CEHURD) as part of the University of Toronto’s International Human Rights Internship Program. Although placed within CEHURD’s strategic litigation team, I was also able to see how the organisations work interacted with its other: community empowerment, HRDA (Human Rights Documentation and Advocacy), and communications teams. The complementary way in which its teams work together is, I think, what makes CEHURD unique, and is what appeared to make its right-to-health- enhancing strategies, highly effective.

On my first day, for instance, I went to the High Court to help report on a case that CEHURD is undertaking on behalf of communities living in Kiryamuli and Bamtakudde. The case concerned the destruction of the communities’ natural environment and water source, contrary to their rights to health and to a healthy environment, among others. The damage – it is alleged – was caused by the defendant’s commercial quarrying activities. The journey to court was not, much to my surprise, spent rehearsing legal arguments, but by a number of CEHURDs lawyers contacting media outlets about the case. Social rights sensitization, particularly through the media is, after all, critical to the rights broad and continued acceptance.  Throughout the course of the internship, it became apparent that this acceptance was necessary not only within local communities, but within Uganda’s legal circles and policy arenas also, and was something that CEHURD was also keenly aware of.

During the summer, for instance, the strategic litigation team organised a Magistrates Forum to bring Magistrates, Academics, CEHURD staff and the media together to discuss human rights questions within the context of the criminal law. How, for example, might socioeconomic human rights protections be respected within Uganda’s somewhat rigid, criminal law provisions? And to what extent are women’s reproductive health rights recognised within the confines of the country’s current Penal code? The day provided a much-needed space for critical dialogue and debate, and illustrated the importance of engaging the judiciary in rights-litigation matters, beyond the courtroom itself.

On the policy front, I saw how CEHURD connects its impressive grassroots research from the many communities it works with, to the policy-level advocacy it undertakes. I was able to attend, for instance, meetings regarding – what is likely to become – the country’s sexual and reproductive health guidelines that CEHURD played a major role in creating.

My time at CEHURD was varied and exciting. Almost every day new issues regarding Ugandan’s rights to health would arise and that I thoroughly enjoyed being able to assist with. What I’ve taken away the most is CEHURDs creative approach to tackling right to health issues, complex issues of a fundamental concern to the Ugandan people.

I thank all the staff at CEHURD, whose passion, commitment and kindness enabled me to have such a wonderful internship and time in Uganda.